Construction of arteriovenous fistulas for hemodialysis. Establishment of a dependable means of venous access is vitally important to patients who require hemodialysis. Physical examination and phlebography are used to assess the most appropriate site for arteriovenous fistula construction. The radial artery and cephalic vein near the wrist should be used whenever possible, but several alternative procedures are available, including the brachiocephalic fistula, and saphenous vein and bovine heterograft interposition. Each operation contributes immeasurably to the comfort and survival of patients with terminal renal failure, and each must be performed with careful attention to detail.


Technique for repair and replacement of the mitral valve. Whenever possible, the patient's own mitral valve mechanism should be preserved. Successful mitral valve repair offers excellent benefits in terms of hemodynamic function, clinical improvement, and longevity. Open mitral commissurotomy or valvuloplasty for localized defects or ruptured chordae tendineae constitutes our best reparative efforts. Today, mitral valve replacement can be accomplished with less than a 5 per cent operative mortality, but should be reserved for patients who are not in desperate terminal condition. In our experience, aggressive tactics undertaken at the endstage of the disease have had little or no long-term success. At the Cleveland Clinic, isolated mitral valve repair or replacement is performed under normothermic cardiopulmonary bypass and anoxic arrest. Generally, the valve is exposed through an atriotomy behind the interatrial groove. Valvular replacement is accomplished by interrupted suture technique, seating the prosthesis at the level of the annulus or below it. Risk is influenced mainly by the chronicity of the valve dysfunction. Patients who have not yet reached a Functional Class IV status or sustained massive cardiomegaly and low cardiac output fare better in both early and late follow-up periods.


Angiographic interpretation and surgical management of right coronary artery obstructions. We have found that even high quality arteriography and multiple projections may not clearly delineate the total extent of disease in a severely obstructed right coronary artery. Selection of the anastomotic site is more often based upon the operative findings. Totally obstructed vessels can be more aggressively explored and opened, because failure of adequate graft reconstruction does not result in significant infarction. Once a subtotally obstructed right coronary artery has been opened, the surgeon must achieve a patent anastomosis in order to avoid acute, possibility lethal diaphragmatic infarction. With careful isolation of the bifurcation and its primary branches, the majority of even heavily calcified vessels can be grafted without endarterectomy. If a totally obstructed and poor quality right coronary artery is well filled by collaterals from the left, it may not be necessary to bypass the right coronary artery when successful grafting of the left anterior descending or circumflex branches or both has been accomplished. Although the right coronary artery is frequently more diffusely diseased than the left coronary branches, with careful selection of the anastomotic site and attention to surgical detail, the vast majority of these arteries can be successfully bypassed.


Phleborheographic technique for diagnosing deep venous thrombosis of the lower extremities. There has been further experience with a new plethysmographic technique for diagnosing deep venous thrombosis of the lower extremity. Now called phleborheography, this technique is highly practical and noninvasive and can be conveniently performed in the laboratory, at the bedside or in the office of the physician by a technician. Interpretation of the permanent tracing may be learned by a physician in a short period of time. Since development of a new specifically designed instrument, the accuracy of the test is approximately 96 per cent when correlatewith phlebography.


Infusion tomography of the gallbladder.

Infusion tomography of the gallbladder. Infusion tomography of the gallbladder has proved to be more specific in the detection of pathologic disease as compared with conventional roentgenologic examinations by showing the wall of the organ instead of the contents. Infusion tomography of the gallbladder has been a useful initial procedure in patients with acute cholecystitis and in those with obstructive jaundice. It has helped to confirm diagnosis in patients with chronic lithiasic cholecystitis and nonvisualized gallbladder or with gallstones with documented on oral or intravenous studies. Infusion tomography of the gallbladder can be done on an emergency basis; it requires no prior preparation of the patient and usually yields an answer within 30 minutes. No significant complications have resulted from the high dose of iodized contrast material. There have been only two false results, one negative and one positive, so the procedure can be regarded as a highly reliable one.


Elastase levels during bile-induced pancreatitis in dogs determined by radioimmunoassay. The changes in elastase levels were studied in the plasma before and after bile-induced pancreatitis. Although the anylase and lipase levels increased markedly, there was no significant increase in the plasma elastase levels, as measured by enzymatic assay. On the other hand, the elastase levels of the blood in the femoral and pancreatic veins as measured by radioimmunoassay, increased to about ten times above the control levels. Similarly, in pancreatitis, large amounts of elastase, determined by radioimmunoassay, was found in the ascitic fluid. At that time, no elastase activity could be determined in the ascitic fluid. In this study, it is suggested that circulating inhibitors interfere with the determination of elastase enzymatic activity but do not interfere with the radioimmunoassay of elastase.


Effects of alcohol on biliary lipids in the presence of a chronic biliary fistula. To investigate the effects of alcohol on bile volume and bile composition, dogs with a Thomas cannula and cannulated common ducts were given loading and maintenance doses of alcohol. Bile was analyzed for total bile salts, phospholipids and cholesterol. In dogs with partial interruption of the enterohepatic circulation, alcohol caused significant diminution of volume and outputs of bile salts and cholesterol. However, when a high bile flow was maintained by intravenous infusion of taurocholate sodium, the effects of alcohol on volume and total bile salts were no longer demonstrated. Fall in cholesterol output, nevertheless, persisted. These results show that alcohol causes significant changes in bile flow and biliary lipid composition and support the existence of a bile salt independent fraction of cholesterol secretion in the dog.


Multimodality therapy in the treatment of regionally inoperable melanomas and sarcomas. Nine patients with regionally inoperable malignant melanoma or soft tissue sarcoma were treated with combinations of intra-arterial chemotherapy, immunotherapy and operation or irradiation or both. Three of the heretofore untreatable patients with melanoma remain clinically free of detectable metastases at three years, three and one-half years and one and one-half years from their recurrence. One nodular melanoma remains well controlled two years after diagnosis, while an additional patient is free of disease several months after therapy. Two of the patients with melanoma died within a year of the onset of the recurrence but maintained the affected limb in useful condition until the time of their death. Two of the three patients with sarcoma remain free of disease at ten and four years. One patient who was known to have distant metastatic disease at the onset of the treatment currently is hospitalized for further therapy for tumor in the para-aortic lymph nodes.


The prognostic significance of ureteral obstruction in patients with recurrent carcinoma of the cervix uteri. The findings of the present investigation confirm that no patient with total ureteral obstruction by recurrent cancer survived longer than two years after pelvic exenteration. In contrast,ver 50 per cent of those patients with normal intravenous pyelograms are alive with no evidence of disease two to ten years after radical operation. There is no question that all patients with recurrent carcinoma of the cervix uteri who are satisfactory candidates for radical operative procedures should undergo exploration to determine the extent of the disease and the possibility to curative resection. However, when total ureteral obstruction is found to be caused by a tumor, patient survival is so limited as to make pelvic exenteration impractical.


Acute renal failure following operation for aortic aneurysm. Thirty-eight patients with acute renal failure following operation for aortic aneurysm were analyzed retrospectively in search of predictors of survival. Of 14 potential predictor variablesonsidered, none taken singly were significant; however, the combination of age, operative interruption of renal blood flow and prior renal dysfunction served as a significant predictor, p less than 0.05. Low survival rates occurred if the patient was over 70 years of age, if renal blood flow required interruption or if preoperative renal impairment was present. High survival rates occured in patients less than 70 years of age who had no interruption of renal blood flow and who had normal preoperative renal function. Although the total mortality rate of these patients with acute renal failure was 61 per cent, only one of 12 patients with favorable prognostic indicators died. Acute renal failure following aortic aneurysm repair has no worse prognosis that that stated in the literature for acute renal failure following other surgical procedures. A virorous therapeutic approach should be maintained despite the advent of complications.


Scintigraphic demonstration of abscesses with radioactive gallium labeled leukocytes. Autologous peripheral blood leukocytes, labeled in vitro with 67Ga citrate, have been studied in 20 patients as a radioactive carrier for the scintigraphic visualization of septic inflammatory areas. 67Ga citrate was added to venous whole blood; following incubation, the blood was centrifugated, and the packed cells were reinfused. Scintiscans were obtained four and 24 hours later. The inflammatory process was demonstrated in nine of nine patients with confirmed sepsis. Eleven patients without sepsis had normal scans. There were no false-negative scans and one-false-positive scan. The selective accumulation of the gallium labeled leukocytes in areas of septic inflammation was sufficient to allow scintigraphic demonstration of the inflammatory area.


Pancreatitis of unusual origin.

Pancreatitis of unusual origin. The anatomic pattern seen in the three patients with contiguous gastric duplications associated with pancreatic ducts evidently predisposes the patient to pancreatitis. In the previous patient reported upon from this institution, the correlation of severe bleeding episodes with attacks of pancreatitis strongly supports the concept of blood blocking the pancreatic ductal system, thereby producing pancreatitis. Passage of viscous mucoid secretions from the aberrant gastric mucosa into the pancreatic ductal system also might retard the normal flow of pancreatic juice, producing elevation of the serum amylase level and pain. Overdistention of the gastric duplication also might be considered as a source of pain, but such mechanisms can be considered only speculation at present. Diagnosis is usually made after more than one exploratory laparotomy. Hemorrhage may result, should the gastric duplication contain parietal cells, leading to hemoductal pancreatitis, hematemesis or melena and anemia. At least one in five patients with a gastric duplication possesses another intestinal duplication. Developmental defects commonly are associated with gastric cysts. Almost identical anatomy was present in the patients with contiguous duplications. That two such rare pancreatic disorders were documented in the same institution within two years suggests that this pattern of developmental defect is more common that had previously been expected.


The surgical management of prolapsed pedunculated submucous leiomyomas. Prolapsed pedunculated leiomyomas of the uterus can best be managed by simple vaginal myomectomy. It is safe, easily performed and generally requires no anesthesia. The risk of complications during and after a major abdominal surgical procedure in the face of infection and anemia is eliminated. Interval hysterectomy, if indicated, may be done four to six weeks after vaginal myomectomy without incurring the additional risk of increased operative morbidity. Additional surgical procedures are not indicated if the pelvic examination remains normal. When large leiomyomas are encountered, the pedicle may not be accessible. Confronted with such a situation and continued blood loss and sepsis, we elected in three patients to replace the tumor within the endometrial cavity and close the cervix. Immediate hysterectomy was then carried out. Blood replacementd antibiotic coverage were instituted in advance of any operative procedure. Other pathologic entities must be kept in mind as a source of uterine bleeding that may be found in association with pedunculated myomas.


Quantification of the capacity of the liver to remove ammonia from the circulation of dogs with portacaval transposition. To quantitate the ammonia that the liver removes from the circulation and to investigate the distribution of this substance during and after an exogenous ammonia load, ten dogs with portacaval transposition were studied by placing catheters in the hepatic and portal veins through the external jugular vein, in the portal vein going to the liver and in the infrarenal vena cava through the femoral vein. A catheter also was inserted into the femoral artery. Blood ammonia levels were measured in each catheter, then an infusion of ammonium sulfate, 0.7 milligram per minute per kilogram for 45 minutes through the infrarenal vena cava, was given continuously. All other catheters were simultaneously sampled at 15 minute intervals during the infusion and for a 45 minute period after it was stopped. By using a continuous infusion of indocyanine green and Fick's formula, the total hepatic blood flow was estimated in five of the ten dogs. Thus, knowing the amounts of ammonia in the hepatic inflow and outflow tracts and relating them to the estimated hepatic blood flow, the hepatic extraction ratios of ammonia were calculated. The estimated hepatic blood flow changed minimally before and after portacaval transposition. The blood ammonia levels in all sites where samples were obtained, except for the hepatic vein, followed uniform patterns. In the femoral artery, the portal vein and liver-portal vein now anastomosed to the infrahepatic infrarenal vana cava-the blood ammonia levels during the period of infusion increased by at least 90 per cent. When the infusion was discontinued, the blood ammonia levels decreased but remained elevated, from 30 to 60 per cent of the preinfusion blood ammonia levels. Blood ammonia levels in the hepatic veins increased some but never exceeded 56 micrograms per 100 milliliters. It also was found that the liver removes 80 to 87 per cent of the ammonia reaching it by means of the urea cycle; the other 13 to 19 per cent of the ammonia returns to the circulation through the hepatic veins and is distributed into the circulation, causing the blood ammonia levels to remain higher for at least 45 minutes after the ammonia infusion load was discontinued than the preinfusion control levels in all the sites where samples were obtained.


Tumors of the liver as demonstrated by angiography, scan and laparotomy. One hundred and eighteen patients with various hepatic tumors proved by laparotomy have been analyzed for accuracy and for pitfalls of preoperative studies, namely, physical examination, celiac and superior mesenteric angiography and liver scan. Angiography is correct in detecting a hepatic tumor in 93 per cent and scan, in 87 per cent, overall. When angiography and scan are combined, tumors are detected in 97 per cent of patients. As for specific location and extent of the hepatic tumor to determine its resectability, angiography is correct in 75 and scan in 62 per cent, over-all. Eleven of 39 resectable tumors were deemed nonresectable in preoperative studies. Although angiography and scan are the best available means of diagnosing hepatic tumors, presently, true resectabilty of hepatic tumors can be determined only be exploratory examination.


The clinical implications of a staging system for carcinoma of the anus. During the past 20 years, several treatment regimens have been proposed for the management of squamous cell carcinoma of the anus. Our results confirm the general impression that a wide abdominoperineal resection is the treatment of choice, although some good results have been obtained with the use of radium implants and megavoltage radiotherapy in isolated instances. In our series, two patients survived nine years with this form of treatment. To dissipate much of the confusion that surrounds the terminology of those tumors arising in the anal region, we concur with Morson's suggestion that they should be designated as keratinizing and nonkeratinizing. There was no statistically difference in survival rate between tumors arising in the anal canal and in the perianal skin. The importance of delimitating the extent of the disease, before any form of treatment is attempted, has been emphasized, and our staging system has been presented. Finally, the question concerning the management of inguinal node metastases has been further developed with special emphasis on their different significance whether they appear early or late in the course of the disease.


The role of wedge resection of the ovary as a cause for mechanical sterility. The role of wedge resection of the ovary in inducing secondary sterility of a mechanical nature has been evaluated. Two groups of patients were studied. Fifty-seven patients underwent wedge resection of ovary because of symptoms of the Stein-Leventhal syndrome. Of these, eight were found to have extensive peritubal and periovarian adhesions after operation. In the second group, a retrospective study was made. One hundred and ninety-eight women were known to have mechanical sterility. Of these, 28 gave a history of bilateral wedge resection of ovaries because of the Stein-Leventhal syndrome. All pelvic operations for correction of sterility carry a considerable risk of adhesion formation.


An assessment of staging laparotomy in Hodgkin's disease. Serious morbidity from an elective Hodgkin's disease staging laparotomy was low in this group of 65 patients. Patients with mediastinal involvement alone and patients having histologic findings of nodular sclerosis with unilateral neck disease with or without mediastinal involvement appear to have a low risk for disease discoverable by lararotomy. In these situations, we believe that the staging laparotomy may be optional provided that the apleen and paraaortic areas are irradiated. The laparotomy does enable the radiotherapist to reduce the volume of normal tissue treated, and we think we are safer in omitting pelvic irradiation in the patient with early stage, asymptomatic nodular sclerosis if the negative clinical evaluation of the abdomen is confirmed surgically. The incidence of major treatment change because of the findings at laparotomy was low, two of 30, in our patients with a normal lymphangiogram. There was a high likelihood, nine of 30, of major change of treatment from the staging laparotomy in patients with an abnormal lymphangiogram.


Hepatic trisegmentectomy and other liver resections. Trisegmentectomy, extended right hepatic lobectomy, is the removal of the true right lobe of the liver in continuity with most or all of the medial segment of the left lobe. Some important features of the operation have not been well described previously. To perform trisegmentectomy safely, a fusion of liver tissue covering the umbilical fissure at the level of the falciform ligament must first be split open in many patients. The left branches of the portal triad structures are mobilized from the undersurface of the liver nearly to but not into the umbilical fissure. The blood supply and duct drainage of the medial segment originate within the umbilical fissure and feed back toward the right side buried in liver substance. They are found with blunt dissection just to the right of the falciform ligament, encircled and ligated. Failure to appreciate this switch back anatomic arrangement may lead to injury of the blood supply or biliary drainage of the residual lateral segment. Parenthetically, the mirror image operation of lateral segmentectomy could result in devascularization of the medial segment if dissection and ligation were performed within the umbilical fissure instead of well to the left of this landmark. In most trisegmentectomies, the left portion of the caudate lobe is not removed. This small piece of tissue is interposed between the lateral segment and the inferior vena cave into which it drains by small tributaries. If the left portion of the caudate lobe is to be excised, it is necessary to ligate the last two posteriorly running branches before the main left trunks of the portal triad structures reach the umbilical fissure. Once this step is taken and if the caudate removal is completed, the remaining lateral segment usually has only one remaining outflow, that of the left hepatic vein. The other principles of trisegmentectomy are the same as with less radical subtotal hepatic resection. These include vascular suture closure of the main outflow veins, avoidance of parasegmental planes that leave behind a strip of devitalized tissue, preservation of intersegmental or interlobar veins, omission of techniques that sew shut or otherwise cover the raw surface of the remnant and provision of adequate drainage of dead space. After trisegimentectomy and also after true lobectomy, this last objective is usually met by leaving part of the operative incision open. Using these guidelines, there has been no mortality with 27 hepatic resections carried out since 1963, including 14 trisegmentectomies.


Occlusion of carotid-cavernous fistula with a balloon catheter. Occlusion of a carotid-cavernous fistula with a balloon catheter appears to be easier and perhaps safer than the widely used trapping procedure. Two cases successfully treated using this technique are reported along with a discussion of the advantages, disadvantages, and possible future improvements in technique.


Visual improvement after chiasmapexy for primary empty sella turcica. Postoperative visual improvement is described in a patient found to have primary empty sella turcica on evaluation of her sole symptom, progressive painless visual impariment. Chiasmal elevation by filling the sella turcia with muscle was found to be an alternative to opening the lamina terminalis and may be preferred in cases of empty sella which lack dense adhesions of the chiasm to the sella floor.


Extreme lateral ruptures of lumbar intervertebral discs. Several cases are presented of extreme lateral rupture of the lumbar intervertebral disc in which symptoms of localized nerve root compression were not manifest and in which myelography was negative or misleading. Ordinary exploration techniques failed to disclose these lesions. The most striking pain patterns seen in these patients were flank pain, gluteal, groin, and sometimes upper anterior thigh pain, induced or aggravated by back motion. This pain, plus radiating leg pain, when it occurred, was generally exceedingly severe and disproportionate to the neurological deficit. Lumbar discography was useful in detecting these ruptures.


Quantitative in vitro vasoactivity of 5-hydroxytryptamine on the human basilar artery. The importance of autacoidal substances in the genesis of cerebral vascular constriction and spasm is an unresolved issue. Comparative vasoactivity of 5-hydroxytryptamine (5HT) and norepinephrine (NE) on the human basilar artery was quantitatively assessed in vitro. 5HT was decidedly more vasoactive in this preparation. Three patterns of vasoactivity were noted with 5HT. Type I was an immediate sustained increase in tension lasting more than 30 minutes. Average increase in tension was 2988 mg (range 120-8600). Type II consisted of a sharp immediate increase in tension to average 1555 mg (range 240-4500) followed by gradual dissipation to base-line levels within 15 minutes. Type III pattern was a lesser immediate increase (372 mg; range 100-850) and more rapid dissipation over ten minutes. NE-induced Type I and Type III activity was present in only six of 20 segments. This study demonstrates that 5HT is vasoactive in human cerebral arteries. Type I sustained contractions may possibly be implicated in spasm. It is hypothesized that such autacoid-induced contraction may contribute to vascular wall ischemia, necrosis, and irreversible constriction as seen in human vasospasm.


Monitoring intraventricular pressure using an implanted reservoir in head injured patients. Intracranial pressure monitoring facilitates the management of patients with severe craniocerebral trauma. The advantages of monitoring from the intraventricular space are outweighed by the increased incidence of infections with this technique. A system using an implanted Rickham reservoir attached to an intraventricular catheter with exchangeable external connections has been used successfully for monitoring intracranial pressure in 34 of 35 consecutive head-injured patients, with one minor infection.


Intracranial subarachnoid pressure monitoring in children. A technique for subarachnoid monitoring of intracranial pressure in children is presented. This is based on a subarachnoid bolt that can be inserted under local anesthesia. The advantages of continuous recording of intracranial pressure in certain conditions such as encephalitis, diffuse encephalopaties, and Reye's syndrome are discussed.


Immediate consequences of spinal cord injury: possible role of potassium in axonal conduction block. Compression injury of the spinal cord of cats produced increased outflux of potassium from the damaged site. Conduction by large axons in sensory pathways of the spinal cord was blocked partially by bathing the cord in solutions containing potassium concentrations of the order of 50-100 mEq/liter. It is suggested that block by increased K+ concentration in the extracellular space could interfere with long tract function immediately after cord injury before the onset of gross structural changes, and that increased extracellular potassium may be a link in the mechanisms producing thses later changes.


Treatment of tumors of the third ventricle: a new and simple technique. A new surgical technique is described for the treatment of benign cystic tumors of the third ventricle. It basically consist of: 1) introduction of a catheter to the third ventricle, therefore to the cyst; 2) suction of all the material of the cyst; 3) connection of the catheter to a ventriculoatrial shunt. A report of five patients with a possible colloid cyst in the third ventricle treated with this technique and the satisfactory results obtained in all the cases, with lack of morbidity and mortality, is presented. A comparison between the traditional surgical procedure and ours, as far as the technique itself and the results are concerned, is made. The simplicity of the technique is emphasized and it is proposed as another solution for the treatment of cystic tumors of the third ventricle.


Spontaneous spinal epidural hematoma during pregnancy. A case of spontaneous spinal epidural hematoma during pregnancy is reported. The patient, three weeks before term, was operated upon successfully. A healthy child was delivered with forceps three days after the operation.


Herpes simplex virus encephalitis simulating a frontoparietal convexity neoplasm. The unusual occurrence of a single, cell circumscribed encephalitis due to herpes simplex virus in the frontoparietal convexity is described and served to underline the importance of considering this pathology in the event of a rapidly expanding lesion presenting in any portion of the brain. The valuable, but limited, usefulness of brain scanning and cerebral angiography in making this diagnosis is discussed. Neurosurgical intervention and brain biopsy are required to make the definitive diagnosis.


Meckel's cave meningiomas with subarachnoid hemorrhage. Two patients with Meckel's Cave meningiomas were initially hospitalized as a result of subarachnoid hemorrhage. Four-vessel angiography was necessary to exclude other causes of bleeding while demonstrating these lesions. Apoplectic presentation in both cases led to early diagnosis and successful surgical therapy. A review of the literature reveals subarachnoid hemorrhage to be a rarity in association with meningiomas. The two patients currently reported are believed to be the only examples on record of hemorrhagic meningiomas arising from the region of Meckel's Cave.


Unusual presentation of a choroid plexus papilloma. An unusual case of a choroid plexus papilloma which completely isolated the right temporal and occipital horns from the remainder of the ventricular system is presented. The tumor secreted large quantities of cerebrospinal fluid and also bled into this obstructed cavity. A gross total removal was accomplished.


Transient postoperative occlusion of the superficial temporal--middle cerebral artery branch anastomosis: spasm, swelling, or thrombosis. Ten superficial temporal-middle cerebral artery branch anastomoses were followed by postoperatvie angiograms. The early angiograms revealed patent anastomosis in six patients. In two patients the superficila temporal artery was severely narrowed and tapered and the cerebral arteries were not visualized. In one the superficial temporal artery was not significantly narrowed but was only patent extracranically. In the remaining patient, the superficial temporal artery was completely occluded. The late angiograms showed the patency of the six originally patent anastomoses, and also complete patency of the three anastomoses in which the cerebral arteries were not visualized.


Complete microsurgical excision of cervical extramedullary and intramedullary vascular malformations. Eleven patients with vascular malformations of the cervical spinal cord have been operated upon at the University of Zürich. Total microsurgical excision was achieved in all. One patient had a lesion which was entirely intramedullary. Nine patients had combined lesions, intramedullary and extramedullary. Only one patient had a lesion which was entirely extramedullary. There was one operative death from meningitis. Another patient improved slightly postoperatively, but eventually died of urological complications. One patient had the operation immediately following his only subarachnoid hemorrhage, and has thus been protected from neurological damage. One patient has had postoperative reversal of his progressive neurological deterioration and severe pain. Six patients severely impaired preoperatively improved dramatically. One patient who was quadriplegic preoperatively has regained function in her upper extremities. The treatment of choice in lesions such as these is complete microsurgical excision.


Medulloblastoma in two brothers.

Medulloblastoma in two brothers. The occurrence of medulloblastoma in two brothers is presented. The striking similarities between two cases in the sex, age of onset of symptoms, clinical manifestations and histological findings suggested a possible role of heredity in the etiology of this tumor.


Adhesive lesions of the nerve root in the dural orifice as a cause of sciatica. The cause of sciatica is elusive in some cases. In a few instances it is due to the development of adhesions about the nerve root at the point of its entrance into the dural sleeve. Seven patients with sciatica in whom surgical exploration disclosed no evidence of a herniated intervertebral disc or other extradural pathology were found to have such involvement of the L5 or S1 root at the dural orifice inside the dural sac. This condition occurred in partial form in two cases and with total incarceration in five. Relief followed radicolysis and partial or total radicotomy.


Cerebral aneurysms of traumatic origin.

Cerebral aneurysms of traumatic origin. This report reviews 41 cases of traumatic cerebral aneurysms, including four cases of our own which are presented in detail. They may follow penetrating or closed head injury, and are usually associated with significant additional intracranial damage. Almost half of the patients presented with a delayed subarachnoid hemorrhage within three weeks of the initial head injury, defining an important neurological syndrome. Those patients whose post-traumatic aneurysms have been surgically obliterated have an associated mortality which is half that of patients treated by nonsurgical methods.


Double compartment hydrocephalus in a patient with cysticercosis meningitis. The authors discuss encystment of the fourth ventricle and upward herniation complicating a case of cysticercosis cerebri. The "double compartment" hydrocephalus followed occlusion of the aqueduct of Sylvius and the foramena of Luschka and Magendie in a patient who had previously received a ventriculo-atrial shunt for communicating hydrocephalus. The clinical presentation of this particular form of double compartment hydrocephalus is discussed.


Scanning electron microscopic observations of common carotid artery endothelium in the rat. I. Crater artifacts. Changes in the endothelial surface of the common carotid artery of the Sprague-Dawley rat were observed by scanning electron microscopy after vessels were removed prior to sacrifice or after gluteraldehyde cardiac perfusion. Rates were classified according to whether the vessels was 1) untouched prior to removal, 2) dissected and observed for a period of time, and 3) clamped and observed. Changes consisted of small 1-6 micron craters as well as smooth or cross-striated endothelial ridges or folds. Clamped arteries appeared to exhibit more frequent craters. In contrast, vessels removed prior to death and briefly washed with saline exhibited craters different morphologically from those vessels perfused with gluteraldehyde. Background endothelial folds also differed from the gluteraldehyde-perfused group, exhibiting a cobblestoned or breaded appearance with distorted endothelial bridges. This supports the suggestion of Nelson that premortem perfusion of heart and ascending aorta with gluteraldehyde is necessary to reduce artifact in arterial endothelial structures.


Scanning electron microscopic observations of common carotid artery endothelium in the rat. II. Sutured arteries. Scanning electron microscopic findings in 26 rats with sutured 1 to 1.2 mm segments of carotid artery indicate a difference in morphological changes beneath clamped areas and areas 2 to 3 mm adjacent to the suture line. Craters similar to those observed in control specimens were seen beneath clamped sites without significant platelet aggregation or platelet adherence to the endothelial wall. In contrast, areas adjacent to the suture line exhibited a pattern of fibrin and platelet adherence to the vessel endothelial wall. These changes appeared to be consistent after one to four hours of observation in most animals. Sutures, although attracting some platelets, did not exhibit platelet and fibrin adherence as marked as that of the adjacent endothelial wall.


Electrical stimulation of the brain. II. Effects on the blood-brain barrier. Acute and chronic studies of the effects of electrical stimulation on the blood-brain barrier (BBB) of the cat cerebral cortex are reported. The findings emphasize the importance of avoiding direct-coupled, monophasic waveforms in stimulating nervous tissue. Biphasic waveforms with balanced charges in each half-wave of the stimulating pulse can be used for up to 36 hours of continuous stimulation if the charge per phase (Q/ph) does not exceed 0.45 microcoulombs. Charge density (QD) is also an important parameter. When stimulating in the bipolar mode, BBB breakdown will occur first beneath the smaller electrode of the pair. Following electrical injury, the BBB will be partially restored within one week, and, with rare exceptions, be completely intact after one month.


Biomechanical responses to open experimental spinal cord injury. This study evaluates the dynamic biomechanical responses of the cat spinal cord during experimental impact injury. Temporal deformations of the laminectomized spinal cord were recorded by a high speed camera (1500-3000 frames/sec). The cinematograph revealed large deformations, the cord being compressed to half its posterior-anterior diameter 7 msec after the onset of the impact. Peak impact force produced by a 20 gm mass falling from 15 cm height (300 GCF) averaged about 1.2 pounds, and the corresponding stress acting on the dural surface reached 42 pounds per square inch (or 2200 mm Hg). Both positive and negative pressure waves were found to be propagated in the cerebrospinal fluid.


Medical treatment of traumatic hyphema.

Medical treatment of traumatic hyphema. Evaluation and treatment of traumatic hyphema uncomplicated by perforation or dissolution of the ocular coats, and the goals of immediate and late treament, are discussed. Results of the author's series of 301 cases are compared to results of other series. The prognosis depends greatly on the size of the hyphema and the immediacy of treatment.


What is refraction?

What is refraction? Various concepts of "refraction," are illustrated. The value of refraction testing for evaluation of eye diseases and general functioning of the visual apparatus is considered. The question of whether ophthalmologists or other eye care personnel should be primarily responsible for performing refraction examinations is discussed.


The fetal alcohol syndrome.

The fetal alcohol syndrome. A specific pattern of malformation involving prenatal-onset growth deficiency, developmental delay, craniofacial anomalies, and limb defects is now recognized in offspring of chronic alcoholic women. Historical evidence suggests that this is not a new observation. A recent French study of 127 offspring of alcoholic mothers indicates that this specific syndrome has been recognized in other parts of the world. Many of the features of this disorder could be related to the kind of malorientation of brain structure seen at the autopsy of one patient described herein. The frequency (43%) of adverse outcome of pregnancy for chronic alcoholic women suggests that serious consideration be given to early termination of pregnancy in severely chronic alcoholic women.


Retrospective and prospective epidemiological studies of 1500 karyotyped spontaneous human abortions. Epidemiologic studies, retrospective and prospective, were done on 1500 abortions collected from 1966-1972. No secular or seasonal variations were observed. From the analysis of the relative frequencies of the different types of chromsome anomalies it is estimated that 1 out of every 2 conceptions has a chromosome anomaly. Maternal-age influence was found only for the autosomal trisomy group, mainly D and G trisomies. No effect of oral contraceptives were discovered. An increased frequency of chromosome anomalies occurred after ovulation-inducing therapy and after occupational exposure of the father to irradiation. No variations in the fertility rate and in the frequency of congenital malformations in births following abortions was noted. The incidence of recurring abortion was mainly influenced by the reproductive history of the couple before the karyotyped abortion.


Gentics of urogenital abnormalities in ACI inbread rats. The frequency of urogenital abnormalities in adult ACI rats was 18.8%. These abnormalities consisted of a spectrum of defects ranging from focal aplasia of the ureter to the complete absence of the ureter, kidney, and tubular genital tract on the affected side. When ACI rats with normal urogenital tracts tracts were crossed with F344 rats the frequency of the defects decreased to a constant level in the F1, F2, and F3 generations. There was no clearly significant decrease in the frequency of the defects in the backcross offspring of (ACI times F344)F1 times ACI matings, but there was a significant and dramatic decrease in the backcross to F344 rats. Attempts to select against these defects by brother-sister matings among normal ACI rats were not successful: 5 generations of inbreeding did not alter the frequency of the urogenital abnormalities. The frequency of the abnormalities was the same in the offspring of affected parents as in the offspring of normal parents, indicating homozygosity of the factors responsible for the defects. The results suggest that the transmission of these defects is polygenic.


The role of beta-adrenergic activity in the production of cardiac and aortic arch anomalies in chick embryos. The sympathomimetic amines isoproterenol, epinephrine, norepinephrine, and phenylephrine are structural derivatives of beta-phenylethylamine and have proportionately different effects on alpha- and beta-adrenergic receptors. Chick embryos in ovo were each administered a single dose of one of these compounds at concentrations ranging from 0.4 times 10(-9) to 20 times 10(-9) mol/5 mul saline during Hamburger and Hamilton stages 20-27. In other experiments embryos were pretreated with the beta-antagonist propranolol and subsequently administered isoproterenol. 743 cardiovascular anomalies were produced. The production of cardiovascular anomalies was proportional to the degree of beta-adrenergic activity of each drug. The frequency of anomalies was significantly reduced by pretreatment with propranolol. At all concentrations tested the anomaly rate was greater in chick embryos receiving an experimental compound than in controls. The general types of anomalies included aortic arch defects, ventricular septal defect, double outlet right ventricle, aortic hypoplasia, and truncus arteriosus. These results demonstrate that activation of the beta-adrenergic receptor mechanism is directly related to the cardiovascular anomalies produced in the chick embryos.


Teratologic evaluation of delta9-tetrahydrocannabinol in mice, including a review of the literature. Pregnant CD1 mice received 5, 15, 50, 150 mg/kg/day of delta9-THC in sesame oil on days 6-15 of gestation orally by gavage and were killed about one day before expected delivery. Treatment had no effect on the maternal weight gain, prenatal mortality rate, fetal weight, and the frequency of gross external, internal, and skeletal abnormalities.


Analysis of limb anomalies induced in vitro by vitamin A (retinol) in mice. Forelimb buds of day 11 ICR-JCL mouse embryos were cultured on liquid medium consisting of 90% Eagle's MEM and 10% fetal calf serum. Experimental medium contained 10 iu/ml vitamin A alcohol (retinol). In controls four of five metacarpals chondrified and the epidermis began to keratinize after 3-4 days of culturing. In experimental explants many pycnotic cells were observed in the peripheral mesenchyme in the hand plate, especially in pre- and postaxial regions. Only 2-3 metacarpals chondrified, and keratinization was inhibited in the experimental explants. Uptake of labeled sulfate was suppresssed by vitamin A. Excess vitamin A is thus thought (1) to act directly on limb buds, and thereby to induce limb anomalies, (2) to induce cell death in the mesenchyme, (3) to suppres the formation of chondroitin sulfate, and (4) to inhibit keratinization.


Mitigation of caffeine-induced teratogenicity in mice by prior chronic caffeine ingestion. Pregnant A/J female mice, which had drunk tap water or a 0.05% caffeine solution for 8-19 weeks after weaning, were each injected sc with 150 or 250 mg/kg caffeine once on day 13 of gestation. After 150 mg/kg caffeine the frequencies at term of fetal death, external malformation, and subcutaneous hematomas were significantly lower in the caffeine- than water-drinking group. After 250 mg/kg caffeine the frequency of fetal death but not of malformations and hematomas was lower in the group with caffeine pretreatment. These findings were explained by assuming that long-term ingestion of caffeine induced and increased rate of degradation of caffeine administered during pregnancy.


Auto-immune hemolytic anemia in two horses. Two cases of Auto-immune hemolytic anemia (AHA) in the horse are described. The pathogenesis of AHA in man is related to the findings in the horses. Besides from routine hematological and biochemical investigations specific data were obtained from the erythrocyte osmotic fragility test, the Coombs test, the serum haptoglobulin level and the cold agglutinin test. The first patient, a six month old Dutch standardbred colt, probably suffered from an acute attack of cold-induced hemoglobinuria with severe anemia and acronecrosis of the tops of both ears and of several parts of the skin that had been in close contact with the cold floor. The second patient, a nine years old Friesian mare, showed a type of AHA resembling the acute hemolyte type of cold agglutinin disease in man. This patient had a clear septicemic picture, extensive bacteriological examination, however, was negative.


Vertebral body deformation causing Wobbler syndrome in a Great Dane. This paper reports a case of cervical vertebral body deformation with gradually worsening posterior paresis in a Great Dane. The ventrocranial part of the body of the seventh cervical vertebra was severely eroded and deformed. This vertebra was tilted in relation to the sixth cervical vertebra producing a stenosis of the spinal canal which was demonstrated by myelography. Spondylolisthesis of the second type of G e a r y's classification was diagnosed. 99mTc-polyphosphate showed no concentration in the affected vertebra as would be found where bony tissues of different maturities are present, indicating the lack of effective repair. Dorsal hemilaminectomy resulted in no improvement.


[Electrical stunning of pigs intended for slaughter(author's transl)]. The present situation in electrical stunning of pigs intended for slaughter is described. The methods permitted by law are reviewed. In addition, the current situation which is marked by many imperfections, is discussed. These imperfections are due to inadequate awareness of the fact that the condition of the animal to be slaughtered is an important factor but also to matters closely related to the increasing economics of scale which are being adopted in pig slaughter-houses. Methods of restraining pigs at the time of stunning, the stunning apparatus (which often receives scant attention) and the interval between stunning and sticking are discussed. Studies in progress or being initiated in the Netherlands are reviewed; as a result of these studies, legal requirements may acquire that significance which they can be expected to have.


[Staphylococci in cheese made from raw milk. (author's transl)]. The presence of markedly varying numbers of coagulase-positive staphylococci per gram (less than 10(2) -- greater than 10(6)) of cheese made from raw milk is reported. In twenty cases, the strains isolated from the cheese were examined for their ability to produce toxins. Eight strains were found to produce toxin A, no toxin being isolated from cultures of the twelve other strains. In two cases, the studies were done because of food poisoning which had probably been caused by the cheese. The number of staphylococci was more than 10(6) in one case (cheese about four weeks old) and approximately 1.5 x 10(4) in another (matured cheese). Subsequent studies showed that rather large amount of enterotoxin A were present in the second cheese. The first cheese was not examined for the presence of toxin.


On the probability of finding an HL-A- and ABO-compatible cadaver organ for transplantation. This paper extends earlier work by Barnes and Miettinen regarding the probabilities of finding an HL-A and ABO-compatible cadaver organ for transplantation to incorporate the dependency of this probability on the continuous time scale. Graphs are derived which enable determination of the length of time required to achieve a certain probability of finding a compatible organ and the probability of finding a compatible organ within any time period. The proposed approach enables the immediate determination of the mean and variance of the required waiting time. The paper provides a practical setting for daily decision-making and enables the physician to more clearly convey information to the patient regarding his chances of finding a compatible donor within any given time period.


Enhancement of tumor growth in allogeneic mice following impairment of macrophage function. Teratoma 402 AX is an embryo-like tumor cell line originally derived from the testicles of strain 129/J mice. This teratocarcinoma grows well in males and pregnant females but poorly in virgin females when given in small doses. Induction of growth of this tumor is syngeneic and allogeneic virgin females was achieved by modification of macrophage function by antimacrophage serum. Tumor-bearing animals of both sexes, whether treated with antimacrophage serum or normal rabbit serum, produce antitumor antibodies of the IgM, IgA, IgG, IgG, and IgG classes. These antibodies are bound to the tumor cell surface and are not cytotoxic to the target cell in the presence of rabbit or guinea pig complement.


Transplantations of isologous prostatic tissue in cleared mammary fat pads of BALB/c mice and F344 rats. The cleared inguinal (mammary) fat-pad of male and female BALB/c mice and F344 rats was found to be a suitable site for maintaining prostate transplants. Uncastrated syngeneic hosts were stimulated by testosterone propionate pellets implanted under their dorsal skin. Transplants survived in testosterone-stimulated male and female hosts for as long as 21 months, at which time the experiment was terminated. However, transplants did not survive in unstimulated female hosts. Histological examination of transplants in stimulated animals showed that the epithelial height was maintained and there was increased secretory activity. Attempts to maintain prostate transplants in spleen, kidney capsule, and in scapulat fat-pad for long periods were unsuccessful. Transplants at these sites survived for less than 1 year, the epithelium was low and irregular, and palpation of the transplants was difficult. The prolonged viability of prostate transplants in cleared inguinal mammary fat-pads should facilitate the study of the effects of carcinogens and/or hormones on the prostate.


Present progress towards the laboratory colonization of African Simuliidae (Diptera). The laboratory colonization of African simuliids would facilitate critical work on many aspects of their biology and onchocerciasis vectors could be studied away from natural breeding-sites. In addition to a review of the literature of past achievements in this field, the authors' own studies are described: these centred on the Simulium damnosum and S. neavei complexes because they include vectors of human onchocerciasis. Other species studied included vectors of Onchocerca gutturosa and avian Haematozoa. Techniques for collecting the various developmental stages of African simuliids are discussed. Adult simuliids may be kept singly in small containers, or together in larger vessels, and fed on sugar-solutions, fruits or flowers. Only two members of the S. damnosum complex (one not yet identified) and one S. bovis complex species are so far known to mate in captivity. Many African simuliids have been blood-fed in captivity from sources including blood-soaked filter paper, birds, rabbits, man and the McMahon feeding apparatus, but results have been inconsistent and a few species have rarely taken blood. Blood/sugar mixtures have given better results, but in most cases normal oogenesis has not subsequently occurred. Some African simuliids lay eggs when kept in tubes, while others do so if placed in water and/or after decapitation. Although some females either fail to oviposit or retain many eggs, others lay a large number, but usually not all develop. The eggs of one species have been temporarily stored at low temperatures, but required protection from fungal attack. Larval development requires adequate water-flow and correct hydro-chemical conditions. Various rearing techniques are described. An apparatus in which the conditions of the water may be regulated has recently been modified for use with the S. damnosum complex and three members of the complex have been reared successfully so far. The Kibwezi form of the S. damnosum complex has been successfully induced to complete every stage of its life-cycle in the laboratory. The reduction of wastage throughout the life-cycle is now being attempted.


Observations on filarial infections and parous rates of anthropophilic blackflies in Guatemala, with reference to the transmission of Onchocerca volvulus. In Guatemala, in areas of different onchocerciasis endemicity and outside the endemic zone, the main anthropophilic blackfly species Simulium ochraceum, S. metallicum, S. callidum and S. gonzalezi were examined for infections with Onchocerca volvulus, other filariae, and non-filarial parasites. Third stage larvae, indistinguishable from those of O. volvulus were found only in 3 females of S. ochraceum out of 3,513 examined. In S. metallicum, 2 females out of 3,121 dissected harboured infective larvae of another filaria species, morphologically different from O. volvulus. Thoracic infections were encountered in all four Simulium species. Only in S. ochraceum was there a correlation between the infection rates in the human and in the fly populations. In the endemic zone, up to 15% of the parous flies were infected, against none in the non-endemic area. Parous S. metallicum showed low over-all infection rates of 0.6 to 2.6%, and had infections also outside the endemic zone, but these could not have been of human origin. Non-filarial infections, including fungi of the ovaries, ciliates, mermithids, nematodes, were commonly observed in Guatemalan blackflies. Parous rates were 40% in S. ochraceum, 23% in S. metallicum, 39% in S. callidum, and 49% in S. gonzalezi. The size of the follicular relics showed a daily cycle in S. ochraceum. They were usually large in flies biting man in the afternoon, but small in flies biting in the morning. This suggests that the flies found a new host the same day, or the morning after they had deposited their eggs.


The fate and migration of microfilariae of a Guatemalan strain of Onchocerca volvulus in Simulium ochraceum and S. metallicum, and the role of the buccopharyngeal armature in the destruction of microfilariae. The migration and fate of microfilariae of a Guatemalan strain of Onchocerca volvulus in Simulium ochraceum and S. metallicum was studied. The anatomical distribution of microfilariae at various times after ingestion was recorded from a study of histological sections of the flies. S. ochraceum showed higher microfilarial intakes than S. metallicum which is probably attributed to an inherent difference in their ability to ingest. The migration of microfilariae out of the mid-gut took place essentially through the expanded part (the stomach). Despite the high microfilarial intakes by S. ochraceum, only a few microfilariae were able to migrate successfully into the thorax (2.6%) whereas in S. metallicum showing a low microfilarial intake, a higher rate of migration was noted (74.5%). The main bulk of microfilariae ingested by S. ochraceum died and disintegrated in the stomach. This was due to the presence of a well-developed cibarial armature in the buccopharyngeal apparatus of S. ochraceum in contrast to S. metallicum where such an armature is lacking. Microfilariae were severely damaged by the cibarial teeth while en route to the stomach. They rapidly underwent profound changes in morphology and staining properties and were often surrounded by clusters of the phagocytic leucocytes in the blood mass. In some flies, microfilariae, apparently damaged, were still entangled in the cibarial teeth 5 minutes to 3 hours after taking a blood-meal.


The prognostic value of head nodules and microfilariae in the skin in relation to ocular onchocerciasis. The examination of 250 cases of onchocerciasis from the Sudan-savanna of northern Cameroon showed a strong association between microfilarial invasion of the eye and microfilarial skin concentrations at the outer canthus. It was also shown that the presence of a head nodule was associated with a high microfilarial skin concentration around the eye. It is suggested that these findings are of practical importance in the field for the early detection of cases at risk of developing serious ocular lesions.


Haematological and immunological responses to the tapeworm hymenolepis diminuta in man. Self-infections with the tapeworm Hymenolepis diminuta were carried out to study the haematological and immunological responses in man. Infection caused pronounced eosinophilia, an increase in plasma viscosity and the production of parasite-specific IgG and IgM. Circulating IgE was not detected. There were no significant changes in erythrocyte values or serum transaminases.


The comparative efficacy of diamphenethide and rafoxanide against fasciola gigantica in sheep. Efficacy of diamphenethide ("Coriban", Burroughs Wellcome) and rafoxanide ("Ranide", Merck Sharpe & Dohme, Ltd.) was evaluated in lambs against 8-week old experimentally induced Fasciola gigantica infection. Results were assessed by the reduction in worm counts at post-mortem examination 8 weeks after treatment. Diamphenethide at a dosage rate of 100 mg/kg body weight was found 99.4 per cent effective. Rafoxanide at a dosage rate of 10 mg/kg body weight showed 98.78 per cent efficacy. Six weeks following treatment, infected animals treated with either drug exhibited significantly greater weight gain than the non-treated infected animals.


A primate, Mandrillus leucophaeus, as natural host of the African lung flukeParagonimus africanus in West-Cameroon. Paragonimus africanus was recovered from a free-living drill (Mandrillus leucophaeus) in Cameroon. This is the first record on the natural infection of a non-human primate with lung flukes in Africa.


Biochemical, immunological and genetic studies in leprosy. I. Changes in serum lactate dehydrogenase isoenzymes, creatine phosphokinase and aldolase activity in different forms of leprosy. Serum lactate dehydrogenase isoenzymes, creatine phosphokinase and aldolase activity were determined in healthy control subjects and in lepromatous and tuberculoid leprosy patients from Ethiopia. Sera from lepromatous patients showed a higher total LDH activity compared with control subject. The values for tuberculoid leprosy patients were similar to those of controls. Sera from normal healthy controls showed a higher proportion of LDH-H form (72%) while lepromatous leprosy patient's sera exhibited a higher proportion of LDH-M form (55%). Tuberculoid leprosy patients showed a pattern similar to that of healthy controls. A possible significance of these observations is discussed. No significant variations were observed in fructose-1,6-diphosphate aldolase activity within the different types of disease and controls. Although creatine phosphokinase levels in different types of leprosy decreased significantly from those of normal healthy, it falls within the reported variation of the activity in normal sera.


Biochemical, immunological and genetic studies in leprosy. II. Profile of immunoglobulins, complement components and C-reactive protein in sera of leprosy patients and healthy controls. Various classes of immunoglobulins (IgA, IgM, IgG, IgD and IgE), complement components (C3 and C4) and C-reactive protein (CRP) were estimated in sera from normal healthy controls and leprosy (lepromatous and tuberculoid) patients from Ethiopia. Higher levels of IgA, IgM, IgG and IgD were found in lepromatous leprosy compared with normal healthy people while in tuberculoid leprosy only IgM, IgG and IgD levels were increased. Borderline leprosy patients showed increase in IgG level only. Although an increase in IgE was noted in lepromatous leprosy, it was not significant; the variations in IgE levels could be due to different socioeconomic background and exposure to intestinal parasites. C3 component was significantly reduced in leprosy patients compared with healthy controls while no difference in C4 component was observed. The results point towards an involvement of the "alternate pathway". A positive test against C-reactive protein antiserum was given by about 20% of the normal healthy controls while more than 60% lepromatous and tuberculoid leprosy patients were CRP positive. The results are discussed in relation to the status of immunoglobulins and complement components in leprosy and possible factors (environmental and genetic) which might affect them.


[Ultrastructural changes in spiral organ receptor cells exposed to noise]. Prolonged exposure to sound (1-12 hr, 100-120 db, 2000-4000/sec) resulted in morphological changes in the receptor cells of the guinea-pig spiral organ. These changes were found to depend on the sound exposure time. A restoration time is proportionate to the time and intensity of the sound stimulus.


[Functional dimorphism in satellite chromosomes in hamadryas baboons]. Dimorphism of satellite chromosomes observed in bone marrow of female as well as male Papio hamadryas, and in continuous cultures of the monkey haemopoetic cells is described. Most frequently the observed dimorphism is expressed in different lengths of satellite arms. The structural dimorphism of satellite chromosomes seen in Macaca, Papio and other genera may seem to originate from different degrees of functional activity of these chromosomes. The active homologue is longer since its satellite arm is less spiralized.


[Membrane potential levels in Acetabularia mediterranea cells during changes in temperature of the medium]. The transitions of vacuole-medium potential difference (EM) has been revealed between two stable levels: -170 mV at 20 degrees, when EM greatly exceeds K+-equilibrium potential (EK equals -104 MV) due to electrogenic Cl-pump, and -82+/-3mV at the critical cooling temperature 9.0+/-1.3 degrees, when EM is close to EK. The control of electrogenic ion pimping on the tonoplast was shown during periodical cooling-heating cycles.


[Analysis of the kinetics of the transition of cells to DNA synthesis in systems with stimulated proliferation. II. Theoretical bases of the method]. New kinetic criteria for analysis of the systems stimulated to proliferate were used for separate description of the initial and repeated entry of cells into the S period after the stimulation. An approach for estimation of temporal parameters of the S period of mitotic cycle is presented.


[Analysis of the kinetics of the transition of cells to DNA synthesis in systems with stimulated proliferation. III. Regenerating liver]. The application of the previously reported methods of kinetic analysis to cell proliferation studies in the regenerating rat liver is under consideration. A fraction of hepatocytes (nearly 60% of the initial hepatocyte number) synchronously entering the mitotic cycle in response to partial hepatectomy has been discovered. The investigation of the temporal pattern of the kinetic criterium qS (t) allowed to make a detailed description of the main features of the transition of hepatocytes to DNA synthesis during the first 40 hours of liver regeneration. Using kinetic criteria of the initial and repeated entry of cells into S-period made it possible to reveal that the prereplicative period in the second mitotic cycle was shorter than that in the first one. Thus, the hypothesis about a special period which is necessary for the quiescent cell to acquire the competence to proliferation is additionally supported.


[Effect of protein synthesis inhibitors on DNA replication. I. Effect of the short-term action of cycloheximide on cell permeability for thymidine in vitro]. The effect of protein synthesis inhibitors on DNA replication was studied on L cells. After a 10 minutes' action of the inhibitors, protein synthesis was seen to be completely blocked, and DNA synthesis decreased by 85%. Four hours after a 20-minutes' cycloheximide treatment, the cells completely restored their ability to protein synthesis and DNA replication and even surpass the control level, due, probably, to a partial cell synchronization in S period. The short action of cycloheximide did not interfere with thymidine uptake by the cells. The rate of the exogenous precursor uptake was even higher than that in the control, apparently, because of its much reduced utilization in the inhibited DNA synthesis.


[Effect of 0.005M CaCl-2 and 0.14M NaCl on the yield and extractibility of histones from rat liver nuclei]. The release and extraction of histones from the nuclei of rat liver under the influence of 0.005 M CaCl2 and 0.14 M NaCl was investigated. A considerable loss of nuclear histones, especially lysine-rich ones, was shown biochemically and cytophotometrically. The preliminary incubation of the nuclei in the respective salt solutions resulted in a more complete extraction of histones. This may be explained by a weaker binding capacity of histones to DNA under the latter conditions. Electrophoresis in polyacrylamid gel showed an increased mobility of histone fractions removed from the nuclei by incubation in the salt solutions.


[Changes in transplantable cultures infected with mycoplasmas isolated from leukemic monkeys]. Four strains of mycoplasms isolated from monkeys with malignant lymphoma and haematosarcoma induced an apparent cytopathogenic effect (CPE) only in the FL culture in the first passage. No visible CPE was observed in L and HeLa, and also in FL cultures of the second and further passages infected with the same mycoplasm strains. However, the infected cultures differed reliably from the control ones by a higher index of cell alteration and by an increased mitotic activity. According to these indices they can be regarded as cultures with a latent CPE.


[Histochemical study of the enzymatic activity of cultivated human macroglial brain tumors]. A histichemical study is presented of the activity of some redox enzymes (succinate dehydrogenase, malate dehydrogenase, NAD-diaphorase and lactate dehydrogenase) in 37 cultured human glial brain tumours. The stages of cell activity at different periods of tumour cultivation and the level of their differentiation in the initial tissue were taken into consideration. The examined tumour cultures showed enzymatic cell polymorphizm. During of period of adaptation of explants, the activity of the Krebs cycle enzymes was low to increase during differentiation and proliferation of cultures. The activity of lactate dehydrogenase elevated in tumour cells from cultures of dedifferentiated astrocytomas and glioblastomas mith marked anaplasia. The activity of this enzyme increased also in the course of advanced necrobiotic changes in the tumour cells.


[Quantitative description of the process of radiation inactivation of cells. VII. Nature of primary radiation lesions leading to reproductive cell death]. The entity of radiation damage of viruses, bacteria and cells is defined by the organization of genetic structures. Asimmetrical chromosome exchanges have been proposed as the main reason of inactivation of di- and polyploid eukaryotic cells. If a single molecule of DNA is taken for the core of chromosome, the exchange is believed to be a consequence of cross-polymerization of two polypeptid strands of the single DNA molecule. Thus, the double strand break of DNA is necessary to produce aberration. A hypothesis is put forward on the identity of primary lesion of chromosome with the double strand break. The experimental survival curve is approximated according to the formula derived from the model. The yield of primary lesions of chromosomes is proposed to be equal to that of double strand breaks of chromosomes in order to examine the validity of the hypothesis. The optimal interaction distance of primary lesions in correspondence with parameters of the survival curve is equal to 0.8 mkm. This estimation is in good agreement with the microdosimetrical data, and the proposed hypothesis is not contradicted.


[Ultrastructural changes in boar spermatozoa during freezing-thawing]. Using electron microscopy, no significant alteration were revealed in the boar spermatozoa suspended for 0.5-1 hour in the medium containing protective stuff except some desquamation and disruption in the spermatozoon head region. Similar picture was seen after a 3 hours' treatment in the medium. However, after freezing (-196 degrees C) and thawing more significant structural changes appear, at first part, in the head membrane structures. In addition, fragmentation and swelling of mitochondria is observed possibly accounting for the lack of spermatozoa motility after thawing.


[Immediate and long-term results of anterior resection in tumors of the rectum and sigmoid (author's transl)]. 127 anterior resections for adenocarcinoma of the rectum and sigmoid were performed at the Istituto Nazionale Tumori from 1950 to 1972. In 48% of cases the site of tumor was upper rectum and recto-sigmoid. The surgical mortality rate was 4,7%. Complications were observed in about 40%, fecal fistula being the most frequent. It seems correlable with the anastomotic technique and is significantly reduced by colostomy. Local failure occurred in 8,3% of patients with maximum rate (28,5%) for tumors located under 12 cm from the anus. The 5-year over-all survival rate was 73,3% with substantial differences according to the extent in initial disease.


[Description of 5 cases of rhabdomyosarcoma of the testis]. The paper reports 5 cases of paratesticular rhabdomyosarcoma in patients of 10 to 18 years of age out of 438 cases of testicular tumours admitted to the Istituto Naxionale per lo Studio e la Cura dei Tumori in Milan (1.14%). Two cases were far advanced and died within a few months despite chemotherapy and radiotherapy. Only one of the three operated patients was cured and is still living 4 years after treatment. This patient had negative nodes and a full course of post-operative chemotherapy. The causes of failure in the other two cases are believed to be: not performing retroperitoneal lymphadenectomy in one and not giving post-operative chemotherapy in both. It is concluded that radical orchiectomy, retroperitoneal lymphadenectomy (followed by radiotherapy in N+ cases) and post-operative chemotherapy are the treatment of choice for operable paratesticular rhabdomyosarcoma.


[Epidemiology of childhood tumors in the Piedmont and Valle d'Aosta regions during the 1965-69 period]. Piemonte and Valle d'Aosta are in the NW part of Italy. In 1967 total population and population aged 0-14 were respectively 4.338.000 and 841.000. During the period 1965-69 a total of 688 cases of cancer (including leukemia) were diagnosed inchildren under 15 years of age resident in this area. The Cancer Registry of Piedmont and Valle d'Aosta (RTP) provided information on 465 children; the other 223 were collected through additional investigation in the files of 31 university of hospital departments of the region and 5 extraregional hospitals. Distribution through the 5 years covered by the investigation is shown in Table 1. Histological or hematological confirmation of the diagnosis was available in 499 cases (73%). The 688 cases included 216 leukemias, 131 tumors of the central nervous system, 40 neuroblastomas, 82 lymphomas (including 34 cases of Hodgkin's disease), 46 nephroblastomas, 32 soft-tissue sarcomas, 29 bone sarcomas (including 5 cases of Ewing's disease), 25 retinoblastomas, 12 thyroid tumors, 10 extragenital teratomas, 5 ovarian dysgerminomas, 4 tumours of the testes, 4 hepatoblastomas and 52 other tumours (Table 2). The number of children under 15 years of age dying of cancer during 1965-69 was 341 (Table 2). Incidence and mortality rates by age groups are given in Tables 3 and 4. The rates were of the same order as those observed in the U.S. and in other European cancer registries during the same period (Tables 4,5 and 6). The mortality rate for nephroblastomas at age 0-4 was 1,09/100.000/year, i.e. slightly higher than that observed in the U.S. in 1960 but about twice as high as that observed in the U.S. in 1967 (14). Incidence and mortality rates for both Hodgkin's and non-Hodgkin's lymphomas were about 3 times higher in males than in females (Table 3). The difference was less obvious during the first five years of life, in which the total number of diagnosed lymphomas was 16.


[Bone marrow scanning (author's transl)]. Personal experience of Technetium-99m-sulfur colloid in the scintiscanning of bone marrow is reported. The method offers technical advantages over other methods and superior protection, while its only limitation is that it does not permit a dynamic study of hematopoiesis. Four pathologic scans typical of four groups of diseases may be distinguished. Further, metastatic bone marrow localisations can be diagnosed much earlier and more precisely than by radiography.


[Description of a case of acute neurological toxicity after DTIC-adriamycin-vincristine therapy (author's transl)]. A case of acute neurological toxicity was observed in a patient with a retroperitoneal fibromyxosarcoma treated with DTIC (NSC-45382), Adriamycin and Vincristine. The neurological symptoms started one hour after drug administration and rapidly declined with symptomatic therapy: no EEG and scintigraphic changes were detectable. The case is discussed in relation to central nervous system complications reported by other authors, following administration of DTIC and Adriamycin.


Possible pharmacological means of treating renal colic. The effects of various drugs on the partially obstructed ureter were investigated in a new model experiment which permitted the calculation of peripheral resistance. After the administration of noradrenaline, the local spasm of the ureter in the region of the obstruction was increased and the urinary flow fell. After administration of the alpha-blocker phentolamine and of the beta-receptor stimulant orciprenaline there was a reduction of the peripheral resistance and an increase in urinary flow due to spasmolysis. Because of its lower side-effect rate, phentolamine is worth investigating in further clinical studies.


The influence of calcium content of water, intake of vegetables and fruit and of other food factors upon the incidence of renal calculi. An area of high incidence of renal calculi in Northern England and Scotland has been found to coincide with an area of soft water supply. However, in Wales and South West England the equation of soft water with high incidence of urolithiasis is lacking, and an enquiry into regional variations in diet reveals that a high intake of fruit and vegetables may protect against renal calculi.


The effect of calculi on transitional epithelium. A clinical and cytological study. An analysis has been made of the 9 false-positive cytologic diagnoses in 4000 samples of urine from 1500 patients. They could be traced to 23 patients who had stones in their urinary tract. After removal of the stones the urinary cytology became negative. Thorough clinical examination excluded malignancy. The histological findings in one of these patients offers a possible explanation for the exfoliation of malignant cells and gives support ot the hypothesis that stones can cause reversible changes of the urothelium with the appearance of a malignancy. A casual relationship between stones in the urinary tract and the development of urothelial cancer could not be established.


Effects of sex hormones on development of urinary bladder tumours in rats induced by N-butyl-N-(4-hydroxybutyl) nitrosamine. Male and female Wistar strain rats were given 0.05% N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) in their drinking water for 6 weeks and then water without BBN for 18 weeks. Diethylstilbestrol and testosterone were implanted subcutaneously into both intact and gonadectomised animals before or after treatment with BBN to evaluate their effects on the development of bladder tumours. Diethylstilboestrol reduced the incidence of bladder tumours significantly in male rats. The incidence was higher in female rats after spaying and administration of testosterone after BBN treatment, than in the intact female. These results suggest that diethylstilboestrol inhibits carcinogenesis of the urinary bladder induced by BBN and growth of bladder tumours induced by BBN, in male rats. On the other hand, testosterone seems to stimulate the growth of bladder tumours induced by BBN in female rats.


The renogram and individual 131I-hippuran clearances in experimentally controlled renal perfusion. The radioisotope renogram and renal clearances using 131I-Hippurate were studied during experimentally controlled renal perfusion. In the first series of experiments, renograms were recorded during variations in renal blood flow produced by an extracorporeal pump circuit. There was a close correlation between renal blood flow and renogram parameters. These characteristics were also related to urine flow rates. In the second series of experiments, unilateral renal damage was produced either by ischaemia or obstruction. Individual clearances using 131I-Hippurate and the gamma camera were compared with standard clearances obtained during a steady state. There was a close correlation between these methods and the results emphasise the importance of subtracting background radioactivity. It is concluded that the main value of the renogram is to provide a left to right comparison of renal tubular function whereas the value of corrected 131I-Hippuran clearances is to provide an absolute measure of individual effective renal plasma flow.


Traumatic kidney rupture in hydronephrosis. The hydrostatic pressure, intrapelvic volume, and specific elasticity and strength of strips of tissue from the parenchyma and the pelvis of eight hydronephrotic kidneys were investigated and compared with the tissue characteristics of the pelvis of four control kidneys. Hydronephorsis manifested itself by a sixfold reduction of tissue strength, and dynamically by a ninefold reduction of the energy absorptive capacity of the parenchyma as compared with the pelvis. Its further response to trauma appeared to be influenced by internal pressure, the law of mass variation, and the energy absorptive capacity of surrounding anatomical structures. The vulnerability of the hydronephrotic kidney in situ depends on its volume and topography, the parenchyma being the part that may be regarded as the site most predisposed to rupture.


The effect of acute chemical sympathectomy on the competence of the canine ureterovesical junction. Selective chemical destruction of the adrenergic nerve terminals in the dog bladder with 6-hydroxydopamine does not result in vesicoureteral reflux. The sympathetic nerve supply of the bladder does not appear to play a role in maintaining the normal competence of the ureterovesical junction.


Urethral hyperthermia: an alternative to urethrectomy. Nine male dogs were subjected to cystoprostatectomy, ileal loop diversion, and urethral hyperthermia. Five of the 9 dogs survived six weeks. Three of the 5 surviving dogs had complete destruction of the urethral epithelium, and the other 2 dogs had 95 per cent and 50 per cent destruction with the proximal urethral end incompletely destroyed. Complete urethral destruction may have been obtained with resection of the proximal urethra postirrigation. The irrigation added no extra time to the surgical procedure and was accompanied by few complications. Complications may have been averted with a dorsal slit and meatotomy.


Comparative evaluation of serum acid phosphatase, urinary cholesterol, and androgens in diagnosis of prostatic cancer. Serum acid phosphatase activity, urinary total cholesterol, and ratio of deoxy to oxy urinary 17-ketosteroids were measured in a group of 42 patients with prostatic carcinoma and in a group of 14 age-matched normal healthy individuals. Our purpose was to evaluate whether or not the simultaneous determinations of these tests would increase the rate of detection obtained by the single assay alone. The results of single assay revealed for the following detection rate: 67 per cent (28 of 42 patients) for serum acid phosphatase, 62 per cent for urinary total cholesterol, and 22 per cent for ratio of 17-ketosteroids. A significant increase of detection rate was observed when simultaneous determinations of two assays were performed; 86 per cent for serum acid phosphatase activity and total urinary cholesterol; 74 per cent for serum acid phosphatase and ratio of 17-ketosteroids; and 74 per cent for total urinary cholesterol and ratio of 17-ketosteroids. A detection rate of 88 per cent (37 of 42 patients) was obtained as all three assays were analyzed, though it was not significantly different from a ratio of 86 per cent for simultaneous assays of acid phosphatase and total cholesterol. It was concluded that simultaneous determinations of serum acid phosphatase activity, urinary total cholesterol, and androgens are of values in diagnosis for patients with prostatic neoplasia.


Urinary incontinence: management with electronic stimulation of muscles of pelvic floor. The evolution of the management of incontinence with electronic techniques is reviewed. Seven patients with urinary incontinence due to various causes were treated with external stimulators connected to intra-anal plug electrodes. One cure, 2 controls, 3 improvements, and 1 failure were noted. There are encouraging signs in the management of incontinence following closure of bladder exstrophy.


Attitudes of patients one year after vasectomy: results of 355 of 1,000 questionnaires. The results of 355 questionnaires are reported, returned one or more years after vasectomy from 1,000 consecutive patients undergoing vasectomies performed by the author from 1959 to 1972. A majority claimed either unchanged or improved health, satisfaction with sexual relations, and frequency of sexual intercourse; 99.5 per cent were satisfied with the operation and in retrospect 96.7 per cent would have the operation again.


Hemospermia.

Hemospermia. A study of 26 patients with primary hemospermia has been made. When primary hemospermia was the only symptom, urologic investigation was normal. It appears that such patients do not require detailed investigation whereas those presenting with hemospermia and other urologic symptoms require further investigations appropriate to those symptoms.


Development of ureteral stone basket.

Development of ureteral stone basket. A new ureteral stone basket is presented which has several advantages over any available: it can be autoclaved, is less than 4 French, and has six wires. Clinical evaluation is included.


Sutureless bivalve nephrotomy with compression hemostasis. Experimental hemostasis in sutureless bivalve nephrotomy was used on 25 consecutive dogs. The result of this study and the review of the literature are described.


Complications of horseshoe kidney.

Complications of horseshoe kidney. A case of horseshoe kidney complicated by hydronephrosis, renal calculi, urinary infection, and tumor of the renal pelvis is reported. The incidence and etiology of the complications are discussed and the frequency of tumors in horseshoe kidneys described.


Prostatic carcinoma: treatment of liver metastases with intravenous diethylstilbestrol diphosphate. A patient with Stage B adenocarcinoma of prostate treated with radical prostatectomy and interstitial radioactive gold presented ten years later with liver metastases without evidence of local recurrence. This patient was treated only with massive doses of intravenous diethylstilbestrol diphosphate, with regression of metastases and marked decline of the acid and alkaline phosphatase levels.


Hypoplastic right kidney with ectopic nonduplicated ureter. Hypoplastic kidney with an ectopic ureter can produce urinary incontinence with its known psychologic disturbances. By diligent urologic workup, the diagnosis may be made preoperatively and appropriate surgical correction undertaken.


Percutaneous nephroscopy using fiberoptic bronchoscope: removal of renal calculus. A method for percutaneous removal of renal calculus within the collecting system is presented. Thus utilized, a flexible fiberoptic bronchoscope with fluoroscopic guidance provides a safe and quick alternative treatment to reoperative surgery for retained renal calculi.


Neuroblastoma presenting as renal cell carcinoma in an adult. A rare case of a fifty-six-year-old female with neuroblastoma is presented. Possible implications as to etiology are discussed, and the radiographic similarities between renal cell carcinoma and neuroblastoma are presented.


Transcatheter embolization of renal arteriovenous fistula. A patient with malignant hypertension and acute renal failure underwent percutaneous renal biopsy which resulted in the creation of an arteriovenous fistula that communicated with the renal pelvis. Successful segmental embolization with gelatin sponge (Gelfoam) was achieved via a transcatheter approach.


Renal angiomyolipoma in adult-type polycystic disease. Two adults with renal angiomyolipomas and polycystic disease are presented with emphasis on the angiographic manifestations of the coexisting lesions. One patient had multiple episodes of gross hematuria and a perinephric abscess which resulted in bilateral nephrectomies; the second presented with hypertension and underwent unilateral nephrectomy to treat a hypervascular tumor. The clinical and radiographic diagnoses of the combined lesions are discussed and suggestions for management offered.


Adventitious hysterogram during intravenous pyelography. This study reports our experience with uterine opacification noted during infusion urography. The phenomenon is observed in 21.7 per cent of urograms performed on adult females. Examples of this entity are presented and the pathophysiology of the uterine opacification discussed.


Treatment of sialocele: an experimental study in dogs. A patient had a delayed complication of parotid trauma, namely a sialocele. He was successfully treated by repeated needle aspiration of the fluid. An experiment using 30 dogs was then done. On each dog, one parotid gland was used as a control, the other parotid was treated by one of three methods that the author felt would be most satisfactory. Needle aspiration was found to be the simplest and the most effective manner of treatment, because the proximal duct quickly becomes obstructed with the cessation of salivary flow, disappearance of the sialocele, and later parotid atrophy. One patient and 30 dogs are surely not conclusive proof of what would be proper treatment, but the author hopes that this paper will stimulate otolaryngologists to try this method if confronted with a similar problem.


Static and dynamic impact trauma of the human larynx. The response of fresh human larynges to static and dynamic compressive loading has been determined for 24 specimens. Mean static force values producing thyroid and cricoid cartilage fractures were 15.8 and 20.8 kg, respectively, and the similarity of this experimental injury to a mild clinical laryngeal fracture syndrome is discussed. Dynamic fracture loading, at velocities up to 11 mph, caused cartilage fractures at forces averaging 30% more, and comparison with the static data is made. Interaction of the thyroid and cricoid cartilages to impact force are analyzed in reference to airway protection. The 50% compressive strain level, at which structural collapse is imminent, averaged 55 kg. The significance of these previously unreported low force levels producing fracture is discussed with reference to automotive design.


Presurgical evaluation of the surgical patient. In summary the presurgical evaluation of the surgical patient is governed by the age of the patient, whether a major or minor surgical procedure is to be done, the amount of time available prior to surgery, and the financial limitations that the client places on the veterinarian following the complete physical examination. The aforementioned variables are then correlated with the patient's physical status to determine what presurgical clinical pathological evaluations are necessary. The patient's physical status is then correlated with the age of the patient, and categories of presurgical clinical pathological testing can be developed. These evaluations range from relatively simple inexpensive general screens, to emergency screens in which time is limited, and and to in-depth profiles that are biochemical and correlated with in-depth evaluations of the cardiopulmonary system, kidneys, and liver. By systematic presurgical evaluation of the surgical patient the surgeon should be better prepared to handle intraoperative and postoperative problems as they arise.


Symposium on surgical techniques in small animal practice. Cryosurgery in the treatment of perianal fistulae. The advantages of cryosurgery over resection techniques in treating perianal fistulae include low recurrence rate, low incidence of incontinence, ease of performance, the relatively short amount of time required for the procedure, and minimal blood loss. If the disease is diagnosed and treated early in its course, complete resolution may be expected after one cryosurgical procedure. However several months and more than one surgical procedure are sometimes required in severe cases. The prognosis is good to excellent, depending on the stage and severity of the disease.


Symposium on surgical techniques in small animal practice. Surgery of the esophagus. There are many anastomotic techniques available that have been used successfully but no one technique guarantees 100 per cent success. Therefore the surgeon should be capable of altering his planned approach according to the circumstances. No matter what anastomotic technique is selected, for a consistently successful outcome it is imperative that the whole animal be considered in all aspects of care and rude handling of tissues be avoided during the surgical procedure. The simple interrupted approximating suture technique is recommend as one which meets the general goals of intestinal anastomosis in dogs and cats.


Myopathy in young cattle associated with possible myoglobinuria. Two 10-month-old heifers from a group of 20 young stock showed symptoms closely resembling paralytic myoglobinuria. One animal died five days after the onset of the symptoms and the other recovered slowly with selenium and vitamin E therapy. Histological examination of muscle tissue from the dead animal showed a myopathy resembling that due to vitamin E deficiency.


Acute and chronic manifestations of Ammi majus induced photosensitisation in ducks. The acute and chronic symptoms seen in ducks following Ammi majus induced photosensitisation are described. The acute changes were inflammatory in nature whereas the chronic changes included severe deformities of the beak and footwebs, mydriasis and eccentric location of the pupil.


Testicular torsion in the dog: a review of 13 cases. The clinical and pathological features of testicular torsion in 13 dogs are reviewed. The affected gonads were intra-abdominal in 11 animals, and inguinal and scrotal respectively in two others. In most cases, the torsion appeared to result from neoplastic enlargement of the testis.


Diarrhoea in horses associated with ulceration of the colon and caecum resulting from S vulgaris larval migration. The clinical manifestations of a diarrhoeic syndrome of horses with ulceration of the mucosae of the colon and caecum are described. Patients could be divided into three groups according to their presenting symptoms and the disease is probably caused by the thrombo-embolism associated with migrating larvae of Strongylus vulgaris. The differential diagnosis, prognosis and treatment are outlined with particular reference to the use of antithrombotic agents.


Acute respiratory distress in cattle.

Acute respiratory distress in cattle. The term "fog fever" was originally used identify a disease of adult cattle grazing lush pastures in the autumn. Unfortunately, the name has subsequently been applied to other respiratory disorders which occurred under different epidemiological circumstances, so that the name "fog fever" has lost much of its original specificity and become almost synonymous with "acute respiratory distress". The pulmonary lesions in 151 cattle, of all ages, with acute respiratory distress are described in this report. While most of the animals were referred as examples of "fog fever", in only 43 of the 151 cases were the clinical signs, epidemiology and post mortem findings consistent with that disease. Twelve other pulmonary disturbances were encountered in the other animals and the pathology of these conditions has bee described.


[Changes in peripheral blood flow during the acute period of severe cranio-cerebral injury (quantitative study)]. The results of a quantitative investigation of the circulation rate and peripheral vascular resistance effected by the method of venous occlusive plethysmography in 37 patients with severe cerebro-cranial injuries are reported. A correlative dependance of changes in the peripheral hemodynamics on the clinical manifestations of a traumatic brain lesion was disclosed. At this juncture three types of the peripheral blood flow changes that corresponded to the syndromes observed were recognized, namely: infra-axial, supra-axial and, pre-eminently, hemispheral ones. The grossest alterations were seen to occur in the case of the infra-axial syndrome of the affection, which manifested themselves in a steep decline of the circulation rate and an appreciable increase of the peripheral vascular resistance.


[Multiple traumatic intracranial hematomas]. An analysis of 133 cases furnished a background to the study of features specific for the clinical course, symptomatology, diagnosis and surgical treatment of patients with multiple traumatic intracranial hematomas. The available clinical material was scrutinized in 3 groups of cases under observation (with "floor-wise", bilateral and "neighbouring" multiple intracranial hematomas) by using a complex set of up-to-date auxilliary diagnostic methods of investigation (EEG, echoencephalography, serial angiography, etc). The results of the surgical treatment were studied depending upon the specificity marking the clinical evolution of the disease, as well as upon the method and technique of the operative intervention.


[Some methods of prevention and replacement of blood loss during surgical treatment of meningiomas of the brain]. To control hemodynamic disturbances during removal of cerebral meningiomas a successful application finds a method of preliminary embolism of afferent vessels of the newgrowth alimenting it from the external carotid system with polystyrene emboli and of direct blood transfusion. The preliminary embolism of vessels belonging to the external carotid system and feeding the tumour was effected in 12 patients. In 18 other patients, operated upon in connection with brain meningiomas, 44 direct blood transfusion were practiced. The described measures are helpful in successfully removing at one time large brain meningiomas with good subsequent results.


[Clinico-diagnostic significance of autoimmune reactions in patients with cranio-cerebral injury]. A trauma of the brain has been found to be regularly attended by the development of anticerebral antibodies. The frequency with which the anticerebral autoantibodies circulating in the blood stream are detected and their titre depend upon the extent to which the brain matter has been damaged. Positive reactions with the cerebral antigen become apparent habitually by the end of the 1st post-traumatic week and continue to be present in the majority of patients till their discharge from the hospital and in cases of more severe injuries-even for a much longer time. Earlier and more distinct formation of anticerebral antibodies found in patients with a repeated cerebro-cranial injury bears evidence to sensitization of the organism with the cerebral tissue antigens.


[Activity of the enzymes of cerebrospinal fluid and blood serum in patients with the concussion syndrome]. The activity of LDG, ACE and CE was determined in the lumbar CSF and blood serum of patients with sustained mild concussion of the brain. As compared to healthy persons the diseased demonstrated a significant rise of the LDG activity in the CSF while the mounting activity of 2 other enzymes, observed in individual instances in the CSF, lacked statistical significance. It was found that in functional upsets without any marked morphological lesions there may be encountered changes in the enzymatic activity that should be considered as a consequence of deranged metabolism.


[Fluctuation of intracerebral pressure in various types of neurosurgical pathology]. During surgery and in the post-operative period fluctuations of the intracerebral pressure and in the dynamics of the local cerebral circulation were investigated in patients with a severe cerebro-cranial injury, acute apoplectic stroke and occlusive hydrocephalia. This was done by using a combined pressure sensor that simultaneously recorded the intracerebral pressure by the volemic method and the local cerebral blood flow-through hydrogen clearance. In patients exhibiting different degrees of hypertension three types of the intracerebral pressure fluctuations were recognized, differing both in their frequency and the amplitude. In some cases the local cerebral blood flow proved inversely proportional to the intracranial pressure.